Venous Thromboembolism (VTE)
Cancer-associated venous thromboembolism (VTE) includes deep vein thrombosis, pulmonary embolism, and central venous catheter-related thrombosis. The incidence of VTE in cancer patients can be as high as 20%, making it one of the most common causes of death following surgery in these patients. Its occurrence is associated with the type of cancer, certain cancer therapies, and patient-specific risk factors for thrombosis, such as advanced age, immobility, obesity, and infections. Cancers with a higher incidence of VTE include brain tumors, pancreatic cancer, gastric cancer, lung cancer, renal cancer, lymphoma, and multiple myeloma. Cancer promotes a hypercoagulable state through the release of pro-inflammatory and pro-coagulant factors, increased platelet count and activity, and reduced fibrinolytic activity, all of which contribute to venous thrombosis.
The prevention and treatment of VTE are addressed in guidelines for aortic and peripheral vascular diseases. However, specific considerations for cancer patients include:
- All cancer patients require VTE risk assessment, and prophylactic anticoagulation should be provided for high-risk patients without contraindications to anticoagulation.
- Patients undergoing high-risk oncologic surgeries, particularly abdominal or pelvic surgeries, should receive prophylactic anticoagulation for 4 weeks postoperatively.
- If VTE is directly related to cancer therapy, anticoagulation should be continued for 3–6 months after discontinuing the cancer treatment.
- For patients with recurrent VTE or long-term cancer survivors at high risk of VTE, anticoagulation therapy should be extended to 12 months or longer, potentially for life.
- Drug interactions between anticoagulants and cancer therapies should be carefully considered when selecting anticoagulant agents.
- Hemorrhage risk assessment should take into account the type of cancer, as certain gastrointestinal and genitourinary cancers may increase the risk of bleeding during anticoagulant therapy.
Arterial Thrombotic Disorders
The incidence of arterial thrombotic events in cancer patients is approximately 1%. Metastatic pancreatic cancer, lung cancer, breast cancer, and colorectal cancer are associated with a relatively higher risk of arterial thrombosis, which may also be linked to treatments involving anthracyclines, cisplatin, and taxanes. These thrombotic events may result from the vascular toxicity of these drugs or may occur secondary to atrial fibrillation. VEGF inhibitors are also associated with arterial thromboembolism. If arterial thrombotic events occur during VEGF inhibitor therapy, the drug should be discontinued, and standard antithrombotic treatment for arterial thrombosis should be initiated.